Dr. Rajasuriya is at present a Senior Lecturer at the Department of Psychological Medicine, Faculty of Medicine, University of Colombo as well as a Consultant Psychiatrist at the University Psychiatry Unit, Ward 59, National Hospital of Sri Lanka, Colombo.

Translated into English by Dr. Geshan Kalupahana

Mrs Sirimanna is a retired teacher. Despite being diabetic for some time, she has complied with her treatment throughout and has led a healthy life while remaining an active figure within her local community and in the village temple. Rather unexpectedly one day, she experienced a chest pain. She felt a little flustered since this was the very first time, and since she already knew that diabetics were at a greater risk of heart ailments. Her husband was even more upset than she was when she discussed it with him, and because there was no one else at home, he telephoned their son who lived close by.

Meanwhile Mrs Sirimanna’s chest pain worsened suddenly. She started to pant and sweat profusely, and was so frightened that she could not speak. Mr Sirimanna was at a loss of what to do. Just then, his son arrived in his three-wheeler and together they bundled Mrs Sirimanna in and rushed her to hospital.

The entire oxygen-saline-ECG routine was run through quickly and within minutes her chest pain improved significantly. Doctors told her the ECG showed no signs of a heart attack, and she was discharged from hospital two days later. Mrs Sirimanna, and also her family, felt she had had a close brush with death.

After two weeks of good health at home, Mrs Sirimanna experienced an identical episode and was hospitalized. Once again she was told that it was not a heart attack, yet this time she was kept back by ward doctors for further investigation.

Nowadays she is invariably hospitalized once or twice each month in a similar manner. A couple of times more, she is taken to the family doctor with a sudden chest pain which appears to subside while the ECG is being taken.

Mrs Sirimanna is afraid to travel now, thinking she may fall ill along the way. She fears climbing stairs and no longer goes to temple. ‘I’m worried that something might happen anytime’, she often tells her husband even when she is well. Although a specific heart disease cannot be identified, Mrs Sirimanna is now very ill and her life has changed considerably.

What has happened to Mrs Sirimanna?

These ‘chest pains’ experienced by Mrs Sirimanna are called panic attacks. Although some people may experience panic attacks on occasion, when they recur frequently as with Mrs Sirimanna they are termed a ‘panic disorder’.

Once more, let us go through the symptoms of these panic attacks that Mrs Sirimanna has to face:

Various physical symptoms such as chest pain and dizziness

Severe anxiety accompanied by a sense of uncontrollable uneasiness

Thinking that one is having or is about to have a heart attack, and that one is getting smothered

Fearing that one is about to die/ fall ill/ faint/ lose one’s mind

Let’s also take a look at what happens in a panic disorder such as Mrs Sirimanna’s: